Provider Demographics
NPI:1871710277
Name:COMMUNITY HEALTH OF SOUTH DADE INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH DADE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SPECIALIST 1
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:NATALIE
Authorized Official - Last Name:DALBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:305-278-6445
Mailing Address - Street 1:10300 SW 216TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1003
Mailing Address - Country:US
Mailing Address - Phone:305-254-4913
Mailing Address - Fax:305-238-7617
Practice Address - Street 1:10300 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33190-1003
Practice Address - Country:US
Practice Address - Phone:305-254-4913
Practice Address - Fax:305-238-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization